Help! Lost 2 lbs. lean body mass, gained 2 lbs. fat.

I'm almost 4 years out.  I started an exercise and diet program with a local gym 2 weeks ago.  I'm supposed to eat 3 meals and 3 snacks daily.  The 3 snacks are protein shakes or pure protein bars.  The meal is a hand size piece of protein, fist size portion of both 1 starch and 1 veggie.  I lost 2 lbs. of lean body mass and gained it in fat after the first week.  The 2nd week I lost 0.5 lbs of fat.  I know my body metabolizes food differently since I had RNY.  What should I be eating to begin losing weight again (losing fat and gaining lean body mass)?  The gym/nutrition expert said 1g. of protein for each lb. of my weight (180 g) and about 1/3 in carbs.  Is there an expert who can help me? 

Thanks,
Jackie

I'm no expert but I am almost 3 yrs out and I have learned this much that might help you:

As an RNY paitent; you still and always will have about a 40% malabsorption condition or saying it another way,...you absorb about 60% of th enutrients form food as regular disgestive tracted person.  So if you take in 100 gms of protein, you get about 60 gms of benefit.

Second,..muscles need protein to grow and carbs to burn.  Reduce the carbs and the body will burn fat until it can't find enough, then it wil cannabolize muscle.  Protein cannot be stored, it is either processed for metabolic use or passed out. Complex carbs are similar but can be broken down but require much more energy. Non-complex carbs or simple carbs are like sugars and fat and are easily converted to storage (fat) by the body if not used.  DOn't put it in the body and the body cannot do that.

So I would be very aware of the types of carbs you are consuming and look at reducing your carbs and focus more on the protein and water/fluids, as after WLS basics.  You can live on protein, water, and your vitamins and supplements.  Anything else is above and beyond based on your level of activity.  I was doing 10Ks and training about an avg of 24 miles a week before I found I needed to raise my carbs for more energy and stamina. Then it became carbs before workout and protein after to recover.

Hope that helps some.  Congrads on getting into a reg workout. And you are right.. Your customized fine-tuned performance engine runs a on slightly different fuel mixture.

"Protein cannot be stored, it is either processed for metabolic use or passed out. "

This is not true. It's all used for something unless you are operating at a calorie excess, then the excess calories (in whatever form they come in) will be stored as fat.

You are right, I stand corrected.  I was told this protein statement as a oversimplification of the chemical processes of digestion by my nutritionist shortly after WLS and have a hard time letting it go as a quick reference.

A little refresher research shows you are absolutely positively right.  Thanks for the catch and corrected guidance for me and al other eaders of this concern as it impacts us all.

Sorry for the misinformation.

Joe

Hey Jackie!

Thanks for posting and I will give you my 2 cents (feel free to give change if necessary ) How do you know you lost 2 pounds of lean muscle mass? It's pretty impossible to lose that kind of muscle mass in 1 week (unless you are starving and dehydrating yourself and even if you did that it might be tough). 4 years out you are not Malabsorbing THAT much, and if you are, it's mostly your vitamins not protein. You ask 100 people's opinion, you will probably get 100 different replies, but I have not seen anything concrete that shows we malabsorb protein after RNY. I believe that increasing protein intake is a great thing, but unless you are working out at a very intense rate 5-6 times a week (2+ hours a day) I think that much protein might be a bit overkill. I run 30 miles a week, cycle 150-200 miles a week, and swim 8-10 miles p/ week and weigh 210 and try to get 150G of protein a day. 50 - 100g would be great I would think for you.

For food: lean meats (fish, chicken, turkey, lean beef), lots of green veggies (broccolli, peppers, cucumbers, etc...) Fruits ... wait, just stick to your basic food groups. Try to get your carbs from fruits and veggies, try to get protein from your foods, but supplementing with shakes is probably a must given our small pouch size, get your fats from olive oil and nuts, also plenty of grains and oats! I eat 4000-5000 calories a day and have learned to develop a healthy relationship with food now. It's fuel. Good fuel = good output...  Bad fuel = crappy output. Just make good decisions, you know what's good for you and what's not... Everyday YOU have to make decisions to attain your fitness / health goals... Excercise or not? Healthy food, or not? Plenty of rest or not? Life is not about a "Diet" or being a slave to the scale, it is about constant improvement. We all fall short and have peaks and valleys in our weight loss, it's just a matter of realizing when you are in a valley and making the necesarry adjustments before too much time goes by so we can get back on track. OK off my soap box now....

Best of luck and please stick around and post how things are going...

Something concrete about malabsorption I have learned about and thought I'd share:

Excerpts from the ObesityHelp.com Facilitator Support Handbook;

Digestion and Nutrition

 

Page 4 -
�� ·Notice that digestion only occurs in three organs: the mouth, stomach, and small intestine. In the gastric bypass patient, most of the stomach and a great part of the small intestine are bypassed, making digestion of foods less efficient. This is known as malabsorption.

 

Page 5-6 - Digestion is the extraction of essential nutrients from ingested food.

�� Digestion begins in the mouth by breaking down food by chewing

�� Chewed food moves through the esophagus and into the intestinal tract, where chemical processes complete the digestive process.

�� Digestion is completed in the small intestine where most of the nutrients are absorbed.

�� Large intestine serves primarily to:

    o Absorb water

    o Absorb electrolytes

    o Eliminate the waste products of digestion

�� Indigestible food particles are stored in the sigmoid colon until they are eliminated

through the rectum.

 

Stomach

● The function of the stomach is to breakdown the chewed food into a semi-fluid

mass of partly digested food, known as chyme.***

● Chyme is then pumped into the duodenum (first section of the small intestine).

The rate of movement of the stomach contents (chyme) to the small intestine is balanced

with the rate of pancreatic and biliary secretions, to permit efficient extraction of nutrients.

 

***IMPORTANT NOTE: This process, which is completed in the stomach, duodenum (beginning of small intestine), and part of the jejunum (farther along part of small intestine), does not happen anymore after a RNY gastric bypass. After RNY the chewed food from the mouth goes into the small pouch that is left, which is then dumped directly into a farther along part of the small intestine. There are no pancreatic and biliary secretions coming into this part of the small intestines anymore. These secretions will not be available until the food reaches the common channel (the lower part of the “Y" connection.

 

This is the malabsorptive part of the Roux-en-Y gastric bypass procedure.  A “normal" stomach also includes secretion of:

● Acid                           ● Intrinsic factor

● Pepsin                       ● Mucus

● Bicarbonate               

These secretions are: Important for digestion; normally very balanced, a mismatch of these secretions can lead to peptic ulcer disease.  In the RNY gastric bypass patient most of these secretions are no longer available for digestion, as the majority of the stomach has been separated from the pouch.

 

(Page 9)

Why protein supplementation?

It’s all about Absorption

Proteins form the body’s main structural elements and are found in every cell and

tissue. Take away the water, and about 75 percent of your weight is protein.

Your body uses proteins:

● for growth

● to build and repair

�� bone              �� muscles

�� hair               �� connective tissue

�� skin               �� internal organs

�� blood             �� virtually every other body part or tissue

 

Besides building cells and repairing tissue, proteins form antibodies to combat invading bacteria & viruses; they build nucleoproteins (RNA & DNA). They make up the enzymes that power many chemical reactions. They also carry oxygen throughout the body and participate in muscle activity.

 

At least 10,000 different proteins make you what you are and keep you that way.  Hormones, antibodies and enzymes that regulate the body’s chemical reactions are all made of protein. Without the right proteins, blood won’t clot properly and cuts won’t heal.

 

Each protein is a large complex molecule made up of a string of building blocks called amino acids. The 20 amino acids the body needs can be linked in thousands of different ways to form thousands of different proteins, each with a unique function in the body.

 

Your body can’t use food protein directly. So after protein is ingested, digestive enzymes break the protein into shorter amino acid chains, and then into individual amino acids. In the gastric bypass patient, this normal digestive process is bypassed.

 

These digestive enzymes are not available until they meet with the food protein in the common channel of the small intestine, and then have only about 5 – 7 ½ ft (compared to 20 ft in a “normal" digestive tract) to do their job. The amino acids then enter the blood stream and travel to the cells where they are incorporated into proteins the body needs.

 

Nine of the 20 amino acids required by human beings are considered “essential" because they come only from the diet; the other 11 are considered “nonessential" because the body can make them.

 

Page 12

How much protein should I be eating every day?

The average*** person (the “normal", NON-gastric bypass patient) needs 50-65 grams*** of protein each day. Considering malabsorption of at least 50%**, the RNY patient will need 100-140 grams per day minimum, which cannot be eaten as food because of the small size of the pouch.

 

**Note: Depending on the length of bypass, the RNY patient may absorb as little as 25% or less. But it is normally agreed that even a short proximal will not absorb more than 50%.

 

***Note: Adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues. That’s about 8 grams of protein for every 20 lbs. Malnourished, septic, pregnant, injured or burned patients will require more protein, in the order of 1.5-2.0 g/kg daily. Extra protein is also required after surgical procedures and illness.

           200 pound person divided by 20 = 10

           8 grams of protein X 10 = 80 grams of protein

           This does not take into count you malabsorption issues.

Hope that helps.

Joe

Found this in my OH.com Support Group Facilitator Manaual; Digestion and Nutrition (page 21) and thought it might help:
The higher on the list, the better the protein source.  The numbers are the BV. (Biologic value).  This is only how easily the (normal) body can absorb them, not the protein grams in each one.  The last few need to be blended to make a complete protein. And remember…. gastric bypass patients don’t absorb nutrients from food protein very well.

What kind of protein is the best?

 

BIOAVAILABILITY OF PROTEIN TYPES 

 

Protein Source                                    BV

Whey Protein Isolate Blends                   100-159

Whey Concentrate (Lactalbumin)             104

Whole Egg                                            100

Cow's Milk                                             91

Egg White (Albumin)                              88

Fish                                                      83

Beef                                                      80

Chicken                                                79

Casein (a protein from milk)                    77

Rice                                                      74

Soy                                                      59

Wheat                                                   54

Beans                                                   49

Peanuts                                                43

 

So, because we (gastric bypass patients) don't have a stomach and the stomach acids, etc, anymore, we don't process the undigested proteins properly and malabsorb most of them.

 

The same is for the normal food we eat. We don't absorb most of it. We, therefore, need

the more highly absorbed, pre-digested protein supplements...whey which is pre-digested (aka hydrolized)...in order to get the proper nutrients our bodies need and are no longer able to get from food.

 

So, whereas whole egg, cow's milk, egg white are near the top of the list of bioavailability

for "normal" people, they are not pre-digested (hydrolized), so for us, they are not as high on the list as pre-digested whey protein. Our bioavailability list would be quite different from the "normal" person's list.

 

So, make sure your protein powder or drink states that it is pre-digested or hydrolized.

And the best kind of protein would be a whey blend protein. Second best would be a 100% whey protein. Isolates, though good for a quick acting pick-me-up, are not sufficient alone for the gastric bypass patients on-going maintenance requirements.

Hope it helps,
Joe

I think that's true post-op for about 12-15months (Honeymoon period) after that your body adapts to the intestinal changes and does not mal absorb nearly as much as recent post-op. That's why those who say they haven't "changed" anything in their eating15 months post-op start gaining weight. Your body learns to hold on to calories and fats again, and unless we start excercising we will be subject to the same weight gain as we were prior to surgery...IMHO have a good one... Again, 100 people = 100 different opinions that's what makes the world go round

An excerpt from the OH.com Facilitator Support Group manual
"Digestion and Nutrition" I thought might be helpful to you also:

Page 23:

If I drink protein shakes and eat too, won’t I gain weight from the added calories?

 

Eating a low calorie diet actually slows down your metabolism.

 

Diets containing more protein can reduce the drop in metabolic rate seen with low calorie diets.  To lose fat, you need to cut down on calories, to consume less energy than you expend. But. Here is the problem. Your body responds to this drop in food intake by slowing your metabolic rate, to keep you alive, which makes fat loss increasingly difficult.

 

Our ancestors had to deal with large variations in the availability of food. Those who survived were the ones whose bodies could adjust to this fluctuation in food availability. Those, whose bodies couldn’t adjust, died.  The result?

 

Our bodies want to hold on to our stores of energy for survival. It thus preserves fat by lowering the metabolic rate whenever food intake drops.  High protein diets reduce the drop in metabolic rate, and also lead to a greater feeling of fullness.

Dr Scott Connelly(1) writes in, “Body Rx: pages 18-19…."Why do MASS protein? To escape fat storage mode, you have to eat more protein.

 

If you want to shut down your metabolism and stay in fat-storage mode permanently, stay on the standard diet prescription- the high-carb, low-protein, low-calorie, low-fat diet. Protein is the key metabolic currency of the body. Your body was designed to run on it. Protein molecules drive all the chemical reactions involved in the breakdown and absorption of food, including carbohydrates and fat. In other words, protein drives virtually all aspects of metabolism. Many studies, including some of my own, show that simply adding protein to your diet turns on your fat-burning/muscle-building switch, even if you make no other lifestyle changes. When I gave one group of body builders extra protein along with their normal diet, they gained two times as much muscle mass as a second group of bodybuilders doing exactly the same workout and eating the same diet but without the extra protein. When you’re stuck in fat-storage mode, you need a  powerful protein boost to jump-start your metabolism back into fat-burning mode. In most

cases, you cannot easily get enough protein from food alone to do the job. To fill the protein gap, in addition to increasing protein consumption through food, I recommend a daily high potency protein powder. It is a simple, safe, efficient way to repair your metabolism and build a lean, shapely body."

 

Muscle uses more calories to maintain itself than fat. People who are more muscular (and have a lower percentage of body fat) are said to have a higher metabolism than others that are less muscular.

 

Footnote(1): Dr Scott Connelly has devoted his life to the science of nutrition and fitness, and is considered around the world as a leading expert in the field of human nutrition and metabolism. A summ *** laude graduate in neuro-physiology from Boston University, Dr Connelly has distinguished his career in anesthesiology, internal medicine, intensive care and cardiovascular medicine. During his internship and residency at Harvard Medical School’s prestigious Massachusetts General Hospital, Dr. Connelly began working with critically ill intensive care patients. In order to help his patients maintain their health, he began researching and formulating products to help prevent the loss of muscle mass. What he learned about the effects of nutrients and exercise on human metabolism, body composition, disease prevention and immune system function. ObesityHelp TM Support Groups Digestion and Nutrition 24 [email protected])

 

Symptoms of slowed metabolism

Fatigue, feeling cold, dry skin, constipation, slow pulse and low blood pressure. These

symptoms could be the result of a medical condition rather than low metabolism – MAKE SURE YOU SEE YOUR DOCTOR to rule out any type of medical problem.

 

How can I increase my metabolism?

Begin to exercise and stop dieting. You can increase your muscle mass by doing some type of resistance work (i.e. lifting weights, using exertubes, rubberbands, dynabands, hand weights, etc…). You can also decrease your level of body fat by doing some type of aerobic exercise at least 3 days a week for longer than 20 minutes. This is exercise such as walking, jogging, step aerobics, hi/low aerobics, biking, swimming, etc, that will increase your heartrate and keep it there for the duration of the exercise session. You also need to eat!  Do not diet, jus****ch the types of foods you eat, and get your protein!!

Thanks for all the advice.  I am reading it, reading it, and rereading it.  The info. on the carbs and proteins have really helped. 

First thing I've done is stick to the 6 meals.  I workout at 5 am, drink a protein shake at 7 am, egg white omelette with veggies and 1 slice whole grain toast at 10 am, then a 19 g. pure protein bar at 1 pm, a small meal around 3:30 pm, then another meal around 6:30 pm, followed by another shake at around 9:30.  I've upped my water especially before, during, and immediately after the workout. I plan to add an evening walk to my day next week.  It's hard to get in all the food.  It's incredible how my pouch has re-adjusted since I started this 2 weeks ago.  I could definitely eat more food 2 weeks ago and had a stronger appetite.  It's like one of those memory foam beds, shrinking down to a smaller size.  I just have to lose the extra 25 lbs. I've gained since surgery 4 years ago.  If I don't, the scale is just going to keep moving up.

Thanks for the support. 

Jackie